Cancer Drugs

Question 1

MOA for Alkylating Agents

Answer 1

Act by changing structure of DNA in cancer cells

Question 2

MOA for cyclophosphamide (Cytoxan)

Answer 2

attaches to DNA and disrupts replication

Question 3

MOA for Antimetabolites

Answer 3

Act by disrupting critical pathways in cancer cells

Question 4

MOA for methotrexate (Folex, Mexate, others)

Answer 4

blocks synthesis of folic acid (vitamin B9) to inhibit replication

Question 5

MOA for Antitumor Antibiotics

Answer 5

Act by inhibiting cell growth through cytotoxicity

Question 6

MOA for doxorubicin (Adriamycin)

Answer 6

attaches to DNA.

Distorts double helical structure and prevents normal DNA and RNA synthesis

Question 7

MOA for Hormones/Hormone Antagonists

Answer 7

slow growth of reproductive-related tumors

Question 8

MOA for tamoxifen (Nolvadex)

Answer 8

blocks estrogen receptors on breast cancer cells)

Question 9

MOA for Natural Products

Answer 9

Kill cancer cells by preventing cell division

Question 10

MOA for vincristine (Oncovin)

Answer 10

cell-cycle-specific (M-phase) agent that kills cancer cells by preventing their ability to complete mitosis

Question 11

MOA for Biologic Response Modifiers

Answer 11

Stimulate or assist client’s immune system to rid itself of cancer cells

Question 12

MOA for interferons,

Answer 12

Slow spread of viral infections and enhance activity of lukocytes

Question 13

MOA for interleukins,

Answer 13

 Stimulate platelet production in immunosuppressed clients
 Enhance capabilities of immune system
 Stimulate cytotoxic T cells
 Increase B-cell and plasma-cell production
 Promote inflammation

Question 14

MOA for sirolimus (Rapamune) and azathioprine (Imuran)

Answer 14

Inhibit aspects of lymphocte replication

Question 15

MOA for Antimetabolites

Immunosuppressant

Answer 15

Inhibit aspects of lymphocte replication

Question 16

MOA for Calineurin Inhibitor

Immunosuppressant

Answer 16

Bind to calcineurin and disrupt T cells, to inhibit helper T cells

Question 17

MOA for Cyclosporine (Sandimune, Neoral) and tacrolimus (Prograf)

Answer 17

Bind to calcineurin and disrupt T cells, to inhibit helper T cells

Question 18

MOA for Glucocorticoid Steroids

Immunosuppressant

Answer 18

Inhibit inflammation

Question 19

Glucocorticoid Steroids

(Immunosuppressant) are use for

Answer 19

Used for short-term therapy for severe inflammation

Question 20

Side effects of cyclophosphamide (Cytoxan)…..

Answer 20

can cause significant bone-marrow suppression

immunosuppressant effects, thrombocytopenia
Nausea, vomiting, anorexia, diarrhea
Alopecia (hair loss), hemorrhagic cystitis

Question 21

Side effects of methotrexate (Folex, Mexate, others) …. Antimetabolites

Answer 21

fatal bone-marrow toxicity at high doses
• Hemorrhage and bruising, low platelet counts
• Nausea, vomiting, anorexia
• Gastrointestinal ulceration, intestinal bleeding

Question 22

Side effects of doxorubicin (Adriamycin)

Answer 22

cardiotoxicity, dysrhythmias
Irreversible heart failure, lower blood-cell counts
Nausea, vomiting

Question 23

Side effects of tamoxifen (Nolvadex)

Answer 23

nausea and vomiting
• Association with increased risk of endometrial cancer and thromboembolic disease
• Hot flashes, fluid retention, vaginal discharges common
Development of cross-gender secondary sexual characteristics
• Common, yet distressing, side effects of sex-hormone therapy

Question 24

Side effects of vincristine (Oncovin)

Answer 24

nervous system toxicity, numbness and tingling in limbs
• Muscular weakness, loss of neural reflexes, pain
• Paralytic ileus, constipation, alopecia

Question 25

Side effects of interferons,

Answer 25

flulike syndrome in 50% of clients (diminishes as therapy progresses) Headache, nausea, vomiting, diarrhea Anorexia, depression, suicidal ideation. With prolonged therapy, immunosuppression, hepatotoxicity, neurotoxicity

Question 26

Examples of Immunosuppressants

Answer 26

 Glucocorticoids  Antimetabolites  Antibodies  Cacineurin inhibitors

Question 27

Antibodies

Answer 27

Basiliximab (Simulect) and daclizumab (Zenapax) - Prevent acute rejection of kidney transplants Infliximab (Remicade) - Suppresses inflammation in autoimmune disorders Muromonab –CD3 (Orthoclone OKT3) - Prevent rejection of kidney, heart, and liver transplants - Depletes bone marrow of T cells prior to marrow transplant

Question 28

Side effects of Calineurin Inhibitor | Immunosuppressant

Answer 28

75% of clients experience reduction in urine flow over 50% will experience hypertension Infections, headache, gingival hyperplasia, elevated hepatic enzymes , hypertension, and elevated hepatic enzymes

Question 29

cyclophosphamide (Cytoxan) is an example of a __________.

Answer 29

Alkylating Agent

Question 30

methotrexate (Folex, Mexate, others) is an example of ________.

Answer 30

Antimetabolites

Question 31

doxorubicin (Adriamycin) is an ______.

Answer 31

Antitumor Antibiotics

Question 32

tamoxifen (Nolvadex) is an ______.

Answer 32

Hormones/Hormone Antagonists

Question 33

vincristine (Oncovin) is an _______.

Answer 33

Natural Products

Question 34

Interferons, interleukins, monoclonal antibodies are examples of __________.

Answer 34

Biologic Response Modifiers

Question 35

sirolimus (Rapamune) and azathioprine (Imuran) are examples of ________.

Answer 35

Antimetabolites | Immunosuppressant

Question 36

Cyclosporine (Sandimune, Neoral) and tacrolimus (Prograf) are examples of ______.

Answer 36

Calineurin Inhibitor | Immunosuppressant

Question 37

Basiliximab (Simulect) and daclizumab (Zenapax) does what?

Answer 37

- Prevent acute rejection of kidney transplants

Question 38

Infliximab (Remicade) does what?

Answer 38

- Suppresses inflammation in autoimmune disorders

Question 39

Muromonab –CD3 (Orthoclone OKT3) does what?

Answer 39

- Prevent rejection of kidney, heart, and liver transplants | - Depletes bone marrow of T cells prior to marrow transplant

Question 40

You'll know it's an antibody because it'll have the suffix....

Answer 40

-ab.... Basiliximab Infliximab Muromonab

Question 41

Hormones other than tamoxifen (Nolvadex) may be .....

Answer 41

palliative rather than curative | Important that both client and family understand this limitation

Question 42

Antimetabolites

Answer 42

fatal bone-marrow toxicity at high doses

Question 43

Nursing Implications: Alkylating Agents

Answer 43

* Discontinue if RBC, WBC, and platelet counts fall * Use caution with hepatic or renal impairment, recent steroid therapy, leukopenia, or thrombocytopenia * Hydrate clients with IV or oral fluids before starting chemotherapy * Advise clients to avoid crowds and those with respiratory infections * Be alert to possible development of blood dyscrasias * Monitor nutritional intake * Assess for nausea and vomiting * Be prepared to administer antiemetic drugs * Offer ice chips or ice pops to relieve mouth pain * Assess skin integrity * Monitor for signs of hearing loss * Inform clients of potential adverse impact on fertility * Alkylating agents range from pregnancy category C to X * Maintain strict medical asepsis

Question 44

Nursing Implications: Antimetabolites

Answer 44

* Contraindicated in pregnancy, hepatic, cardiac, and renal insufficiency; myelosuppression; and blood dyscrasias * Avoid pregnancy for at least six months after therapy with category X drug * Adverse effects common to other antineoplastics may occur * Monitor for photosensitivity and idiosyncratic pneumonitis * Teach clients to use good oral hygiene and encourage mouth rinses * Monitor IV site frequently for extravasation

Question 45

Nursing Implications: Antitumor Antibiotics

Answer 45

* Assess cardiac status—obtain baseline ECG * Assess for pregnancy and lactation * Produce same cytotoxic effects as other antineoplastics * Risk of hypersensitivity reactions exists as with other antibiotics * Changes in rectal mucosa contraindicate suppositories or rectal temperatures * Wear protective clothing (gloves, mask, and apron) when preparing drug * Monitor IV site because doxorubicin is a severe vesicant * Give drug through large-bore, quickly running IV; monitor for extravasation

Question 46

Nursing Implications: Hormones and Hormone Antagonists

Answer 46

• Assess for pregnancy and breast-feeding • Hormones other than tamoxifen (Nolvadex) may be palliative rather than curative o Important that both client and family understand this limitation • Development of cross-gender secondary sexual characteristics o Common, yet distressing, side effects of sex-hormone therapy • Fertility sometimes affected • Discuss these effects frankly with client, and offer support

Question 47

Nursing Implications: Natural Products

Answer 47

• Assess allergy to plants or flowers, including herbs or foods • Vincristine (Oncovin) may produce acute bronchospasm and skin rashes • Inquire if female clients are pregnant or breast-feeding • Many of same cytotoxic effects as other antineoplastics • Emphasize need to establish nutritional plan to combat constipation o High fluid and fiber intake • Monitor blood pressure • Observe clients for symptoms such as headache, dizziness, or syncope • May produce severe mental depression; assess possibility of suicidal ideation

Question 48

Adverse effects of therapy (general for all of them... serious)

Answer 48

• Alopecia • Mucositis (severe nausea, vomiting, diarrhea)  Drugs with high emetic potential pretreated with antiemetics (Compazine, Reglan, Ativan) Vesicants  Can cause tissue injury (extravasation)  Know emergency treatment before giving vesicants IV Long-term consequences  Possible infertility  Increased risk for secondary tumors

Question 49

Nursing Implications: Immunosuppressents

Answer 49

 Contraindicated in client with leukemia, metastatic cancer, active infection, renal or liver disease or those who are pregnant  Obtain vital signs and results of lab testing to provide baseline data  Monitor for indications of infection  Monitor degree of bone-marrow suppression (thrombocytopenia and leukopenia)  Monitor clients taking azathioprine (Imuran) for development of secondary malignancies

Question 50

Nursing Implications for Immunization Agents

Answer 50

 Assess for risk-based precautions: pregnancy, diabetes, heart disease, renal failure  Provide education on importance of receiving vaccinations  Answer questions and concerns regarding risks and benefits of vaccines  Instruct on recommended immunization schedule and follow-up vaccines

Question 51

A Vaccine provides

Answer 51

ACTIVE immunity.